Healthcare Provider Details

I. General information

NPI: 1841221678
Provider Name (Legal Business Name): DAVID HERVIG PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 09/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9908 SR 64 EAST
BRADENTON FL
34212-5303
US

IV. Provider business mailing address

367 S. GULPH RD ATT: IPM CREDENTIALING
KING OF PRUSSIA PA
19406-3121
US

V. Phone/Fax

Practice location:
  • Phone: 941-747-8600
  • Fax: 941-749-5915
Mailing address:
  • Phone: 775-356-9393
  • Fax: 775-356-5590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9102767
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: